From MeritBadgeDotOrg

The National Medal for Outdoor Achievement was introduced in 2010 as "the highest recognition that a Boy Scout or Varsity Scout can earn for exemplary achievement, experience and skill in multiple areas of outdoor endeavor", according to the 2011 edition of Boy Scout Requirements.

5. Complete a 16-hour course in Wilderness First Aid from the American Red Cross, Wilderness Medical Institute, or other recognized provider.

6. Become a Leave No Trace Trainer by completing the 16-hour training course from a recognized Leave No Trace Master Educator.

7. Plan and lead, with the approval of your unit leader, an outing for your troop, team, patrol, or squad in two of the following activity areas: hiking and backpacking, aquatic activities, or riding. Include in each outing a service element addressing recreational impacts resulting from that type of activity. With the approval of your unit leader, you may plan and lead the outings for another Cub Scout pack, Boy Scout troop, Varsity Scout team, Sea Scout ship, or Venturing crew.

8. Complete at least one of the following:

b. Plan and lead, with the approval of your unit leader, an adventure activity identified in the National Outdoor Badge for Adventure for your troop, team, patrol, or squad.

a. Successfully complete a season on a council summer camp staff in an outdoor area, such as aquatics, Scoutcraft, nature/environment, climbing, or COPE.